IVF Basics: Everything You Need to Know about IVF
In this article, I’m going to share everything you need to know about IVF. You may already know many of the things I’m sharing, but I’m hoping that you’re going to learn something new that you can take to your fertility doctor and feel more empowered as a result of participating in today’s session.
The Egg Whisperer DIET: Test, Don’t Guess
The first thing I want to talk about today is assessing your fertility and what you can do to improve your chance of success. Why? Because it’s so important to know what your diagnosis is before you do IVF. I know that sounds so weird and so lame. Isn’t IVF supposed to fix everything? The answer is no.
I’ve come up with something called The Egg Whisperer DIET. For those of you who don’t know, I was lovingly called The Egg Whisperer by one of my sweetest and dearest patients, and then she bought me a website called EggWhisperer.com as a gift, and that’s how it all started. I’ve used these terms to help patients and remind them what to ask their doctor and how to be more empowered and more informed.
My mantra is test, don’t guess. Very simple words to remember and live by. The Egg Whisperer DIET stands for:
D: diagnosis
I: IVF cycle
E: embryo transfer preparation
T: transfer.
That’s what makes up the DIET. It is my recipe for success.
D is for Diagnosis
How do you figure out what your diagnosis is and why does it matter? It actually matters a lot. You want to make sure that your doctor is planning your IVF cycle in a way to address the diagnosis.
I’ll share a scenario with you. The other day I did a second opinion consult and the husband had low motility, motility was around 15%, and no one really told them that was the diagnosis. They thought they were unexplained, which in my mind and in my world means that no one explained it enough to you. The doctor did IVF and they did not do ICSI. ICSI is where you take a single sperm and put it into the egg. If you think about it, that could be pretty frustrating when you wake up after the egg retrieval and find out that there are no fertilized eggs. The diagnosis, if you had understood it and you had designed your IVF cycle to address it, that could have been prevented, you wouldn’t have learned your diagnosis the hard way.
Do whatever you can to talk to your doctor about, “What have you ruled out about me? What do you know about me?” If they say it’s unexplained, if you’re a 44-year-old who was told it was unexplained, I can promise you it’s not explained.
You want to talk to your doctor about what you can do that’s in your control to give yourself the best chance of pregnancy. “If you’re telling me it’s unexplained, what are the possible explanations for me?” Then you can use the words, “What have you ruled out?” There should be a song that goes in there somehow.
The TUSHY Method Gets you to a Diagnosis
Another pneumonic, and that is the TUSHY method. That’s how you get to the diagnosis. The five steps to figure out your fertility. It seems complicated, but I try to make it not so complicated, life is complicated enough. TUSHY method here we go:
T: Tubes
U: Uterus
S: Sperm
H: Hormones
Y: Your genetics.
You can get it all tested in one month.
In one cycle your period starts, cycle day 3 get your FSH, estradiol, AMH, all your hormones and your preconception labs drawn. Do your carrier screen and chromosome analysis if you haven’t done them already. Order your HSG done between cycle days 8 through 10. Get an ultrasound done between day 3 and day 8 through 10, so that if you have a big fibroid or a big ovarian cyst, you want to know that before your HSG appointment.
Order a semen analysis. If your site isn’t doing semen analysis because of COVID right now, no big deal. Go to MeetFellow.com/eggwhisperer and you can get a do-it-yourself semen analysis kit delivered to your home. If only it could be that easy for women that we could just put our eggs in a cup and send them off to be frozen or analyzed, but it’s not. Until then, we have to sleeves up, pants down. You know what I’m talking about.
It’s super important to find out your diagnosis before your IVF cycle. If it has been more than a year, do it again, especially if you’re going to do IVF, especially if your doctor is telling you that your diagnosis is unexplained.
Preparing for Your IVF Cycle
Now let’s talk about preparing for your IVF cycle. The things that I talk to my patients about are this…
Look at your lifestyle. It’s not about losing weight, it’s about the healthiest lifestyle. Some of the most traumatic doctor experiences I’ve had growing up and even two or three years ago would be providers telling me that I’m too heavy. And they didn’t use words like that, they were actually quite mean. I would never do that to anybody.
The way I talk to my patients, because I think they’re beautiful and they’re healthy, they’re young and they’re fertile, and that’s how I see them, is that I want them to be as healthy as possible. Strength training, eating right, plant-based diet, all that kind of stuff, sleeping well, making sure that you have a normal circadian rhythm, make sure your relationships are in the healthiest state.
Gather Your Fertility TEAM
I came up with another pneumonic, and that’s the Fertility TEAM.
T: therapist
E: eating and exercise specialist or nutritionist
A: acupuncture
M: mindfulness and meditation.
Consider Supplements
Preparing also means taking supplements. Supplements could be CoQ10. It could mean N-acetylcysteine, if for example you have endometriosis. It could mean Tru Niagen and pterostilbene, Resveratrol, and Acai berry if you have decreased ovarian reserve. You can see that I have my certain recipe that I recommend to my patients. Ask your doctor what their recipe for supplement success is.
Some people call it a supplement soup. I just call it my Egg Whisperer special sauce, and I swear it’s magic. For some people it works, for other people it doesn’t, but I really think at least taking a prenatal, CoQ10, Vitamin D, fish oil. Then adding in Tru Niagen and all the other things that I explained, and then Ovasitol if you have PCOS.
If you have PCOS, you want to make sure that your hormones are balanced and you’ve healed it. If you have endometriosis, talk to your doctor about have you ruled adenomyosis, is it possible the endometriosis is affecting the tubes and then hydrosalpinges. All super important stuff.
That’s how we prepare. Healthiest, most sane, most relaxed that you can possibly be before going into your IVF cycle. And if you’re in a partnered relationship, make sure your relationship is really strong. Take the time, take a break, take all of the necessary measures to make sure that you guys are on the same team and this is right for both of you.
Your IVF Options
Is fresh better than frozen? Is frozen better than fresh? Should I do this or should I do that? I’ll break it down for you.
You basically have two IVF options, transfer fresh or transfer frozen. Fresh means putting in an embryo about five days, or even three, after an egg retrieval. Five days after an egg retrieval that embryo is called a blastocyst, it has hundreds of cells. You can also then freeze the embryos.
Freezing means you now have two options, genetically test or not. I call genetic testing the murkiest of murky of murky crystal balls, but it’s the best we have. Think of embryos as diamonds. Embryos, like diamonds, can be beautiful on the outside and they sparkle. Diamonds sparkle, too. But a diamond on the inside means the diamond is really good. An embryo on the inside when you’re scrolling through the microscope, you can’t see the chromosomes. That’s why genetic testing can help.
The three questions that I always ask my patients: What do you want? What is it going to take to get what you want? Are you willing to do it?
What do you want means how many kids do you want? What is going to take at the time of that fresh transfer, if you’re doing it fresh, if you want two or three kids, and because of your age and everything that your doctor knows about you, you have one embryo, then you might want to freeze. Don’t go into that fresh embryo transfer, because you’re not honoring the things that you want. Make sure you talk through those things with your providers, with your partner, and make sure that you’re on the same page so that you feel like you really made the right decisions for yourself.
Embryo DIAMONDS
I know, I can hear you guys say she has now come up with another pneumonic, and it’s true. Embryo DIAMONDS, the eight things you need to know about your embryos.
D: What day were they frozen or transferred on
I: the implantation rate per embryo
A: Abnormal
M: Mosaic: Then with mosaics find out from your clinic what their mosaic transfer and reporting protocol is before you do genetic testing.
O: Official Reports: You don’t want to be surprised if they won’t report it to you or if they’ve discarded an abnormal embryo that could have been normal in the end if it was mosaic. Get all of the official reports, stim sheet, ultrasounds. I love my patients to have their DIAMOND binder.
N: Then we go to the N, which is how many are normal.
D: The D, do these embryos help you reach your dreams and goals.
S: The S is how is the sperm on the day of the egg retrieval.
Fresh or Frozen Transfer?
Now you have fresh and you have frozen. With frozen the two options are freeze to genetically test or freeze to transfer. Now you have a decision to make of whether you want to do one of two things. I know, my husband is always telling me I give people too many options, but I just want people to know everything that is available to them without making any assumptions about what they would do and just giving them basically a roadmap and then you get to choose your own adventure. I like the word adventure. I don’t like other words like roller coaster. I try to keep it as a nice adventure with, hopefully, the best and easiest and most efficient happily ever after.
Focus, two things. You have frozen embryos, to transfer or not. We already talked a little bit about the genetic testing piece, but to transfer or not means back to the Egg Whisperer DIET. We have the D for diagnosis, I for IVF, which I kind of just talked through, E is embryo transfer preparation.
Ask Questions and Take Your Time
Take your time. Talk to your doctor about what have you ruled out, are my labs normal, is my lining normal, is my cavity normal, why are you choosing the protocol to transfer that you’re choosing for me, is my progesterone going to be enough, how can you reassure me about that. Use the words, “What have you ruled out?” Just say it over and over. “What do you see in this ultrasound? What do my hormone levels show you about me? Is there anything I can do to give the best chance of pregnancy before this transfer? Do you really feel that I’m going to give myself the best chance of transfer by doing it right now?”
Then the last question, the most important question, “Doctor, what would we do if this transfer didn’t work?” Because guess what? Sometimes you would want to know that because you might want to do that first before you do the transfer. For example, if I had a patient that just had one embryo and she was 42 years old, what we might do is do another cycle now. You don’t want to find that out after transfer didn’t work or you unfortunately had a miscarriage. You know what I mean? That would be pretty annoying to think, “No one told me enough about ovarian aging and how important it was to do another cycle first.”
Transfer Preparation and Implantation Testing
So, embryo transfer preparation, we also have implantation testing. I call it the mock cycle. You can do it with an ERA test or the Receptivadx test, or both. Talk to your doctor about what test they do for their patients. I do both. I think that the ERA test is the e-invite to the funnest and best party. It basically tells you exactly what time to show up. The Receptivadx test tells me what to wear to the party, it basically tells me what protocol I should use that will hopefully give my patient the very best success rate.
Now the transfer. You guys all know what a transfer involves. It’s basically going to a lab, feeling relaxed, maybe doing a little something before and after, and something is acupuncture before and after, and then getting that embryo home. The most important guest in your home, which is your uterus, is that embryo. You want to welcome it, you want to feel like you’re well prepared, not overwhelmed, not stressed or feeling rushed about any decisions you’re making. Hopefully that embryo is going to do everything it needs do, which is stick and grow.
What to do After a Failed IVF Cycle
The next thing that I want to talk about is dealing with a failed IVF cycle. That is so hard. What I tell my patients is, first of all, I’m really sorry. You didn’t deserve this. You didn’t cause this. The thing is this. When my patients have a negative pregnancy test or a transfer that doesn’t work, they know that I’m not going to bed at night unless I feel like I’ve given every single person their best chance of IVF success. I’m not doing a transfer unless I’ve ruled out and talked through all of the things that I’m talking to you guys about right now.
It’s so important to talk to your doctor, too, about these things before your transfer, otherwise you’re going to be kicking yourself, “Why didn’t I ask that question?” The problem is a lot of people just don’t know what questions to ask.
Now you have, unfortunately, a failed IVF cycle. I digressed a little bit. You have to give yourself the space that you need to get through the moment. Don’t make any big decisions. Don’t throw everything away. I’ve had patients do that, they throw everything away in that moment. Don’t do anything irreversible. Know that your feelings will change and give yourself space and take the time that you need.
Reconnect, regroup, and make a plan. I always bring my patients in for a post-IVF consult within no more than a week from that transfer so that we can go through everything we did, everything we learned, answer your questions, I’ll listen to your gut feelings on things, and we’ll talk through all of the things that I’ve talked to you guys about. Ask your doctor the same questions, “What have you ruled out? What can we do next? What’s our plan?”
Then get excited, get hopeful, and try again. It’s really hard to have hope right now, it’s really hard to be positive. That word positive can be super annoying, especially when you have family members that are like, “Just be positive and everything is going to work out,” and you’re like as if that was a thing. But I talk about hope as four things. I know, another pneumonic. Have only pragmatic and practical and positive expectations. Notice the first P is not positive. I still want you to be positive, of course, but more so practical and pragmatic is the most important. And strong and resilient. That’s why you guys are here and watching me today.
Pregnancy After IVF
Now let’s go to the good stuff. That’s when you’re finally pregnant with that embryo and what to expect along the way.
The first thing to know is that you’re going to feel anxious and you’re going to feel worried, and you’re going to think that something is going to be wrong all the time. It’s going to be really hard to reassure you, so it’s really important for you to talk to your doctor about how they can reassure you and what they can do to continuously reassure you that everything is going right.
The things I do for my patients are HCG progesterone levels, I check them about three times, and then once a week until the ultrasound. After the ultrasound, I ask my patients about how they’re feeling and when they want to be seen again. Then I get them to their OBGYN usually between 10 and 12 weeks of pregnancy. Make sure that you have a care team that is treating your pregnancy like a VIP, a very important pregnancy.
I hope you guys are all sparkling out there. I commend you and I am so impressed by you that with all the things that are going on in the world that you are working so hard to bring love into your life and into our world. I know everyone who is going to be a mom and a dad right now with what is going on is going to make this world a better place. That’s what gets me fired up. That’s what gets me showing up.
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